Healthcare Provider Details

I. General information

NPI: 1356610703
Provider Name (Legal Business Name): LISA CAROL YEE B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 FARRELL DR
COVINGTON KY
41011-3775
US

IV. Provider business mailing address

1201 S FORT THOMAS AVE
FORT THOMAS KY
41075-2421
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-3208
  • Fax:
Mailing address:
  • Phone: 859-781-5586
  • Fax: 859-781-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: